Pacemakers for Diaphragm Paralysis
Breathing pacemakers are indicated for patients with diaphragm paralysis who would otherwise be completely or partially dependent on mechanical ventilation so long as the phrenic nerve(s) and diaphragm(s) are intact. Patients with diseases in which the phrenic nerves have completely demyelinated, such as advanced ALS, or the diaphragm muscle is irreversibly atrophied,such as muscular dystrophy, are not candidates for diaphragm pacing.
What is Diaphragm Paralysis?
Diaphragm Paralysis is the loss of control of one or both hemidiaphragms caused by a traumatic injury or disease process which decreases or terminates the impulse of respiratory stimuli originating in the brain. Causes of diaphragm paralysis include, but are not limited to:
- Central neurological disorders such as a brain or brainstem stroke,
- Spinal cord disorders such as syringomyelia or poliomyelitis,
- Direct trauma to the phrenic nerve from surgery, radiation or tumor,
- Autoimmune diseases such as multiple sclerosis,
- Demyelinating disease processes such as Guillan-Barré syndrome and ALS (Lou Gehrig’s Disease),
- Phrenic nerve neuropathy, viral or bacterial infections, and idiopathic (ie, unknown) etiologies.